Governments That Bar Injection Drug Users From Treatment Fuel Spread of HIV, WHO Official Says

The World Health Organization on Thursday at the XV International AIDS Conference in Bangkok, Thailand, warned that countries preventing injection drug users from receiving treatment are fueling the spread of HIV, Agence France-Presse reports (Agence France-Presse, 7/15). There are about 13 million injection drug users worldwide -- including 10 million in developing countries -- and up to 90% of them could be HIV-positive, Andrew Ball, manager of HIV/AIDS support at WHO, said. Although HIV-positive injection drug users in developed countries have relatively good access to antiretroviral drugs, those in other regions such as Eastern Europe "are excluded from any form of treatment," Ball said. Many drug users avoid seeking medical care because they fear police action or forced drug rehabilitation. In addition, many health workers have "very negative attitudes" toward injection drug users -- attitudes fueled by "myths ... that drug users aren't adherent to treatment, that there is very little value in investing in drug users by providing them with expensive treatment ... that they're not really contributing to society," Ball said (Lovering, Associated Press, 7/15). "[D]rug users are routinely written off as unreachable and non-compliant," Jim Yong Kim, director of WHO's Department of HIV/AIDS, said. However, "[a]vailable data show clearly that drug users, offered the right support from the health sector, receive the same benefits from treatment as other people with HIV," Kim said, Reuters reports (Cropley, Reuters, 6/15). Ball said that WHO strongly supports "street drug" substitution programs. Although WHO cannot make methadone and other substitutions for street drugs widely available, the organization supports adding such drugs to its "Essential Drugs List" (Bangkok Post, 7/16). Ball called on countries to create HIV prevention programs for injection drug users that promote abstinence and help treat addiction. In addition, WHO called on countries to provide counseling, outreach, needle exchange and condom distribution programs (Lovering, Associated Press, 7/15). Drug programs should ensure greater access to antiretroviral drugs for injection drug users by providing easier doses, such as once-a-day medication and by offering both HIV and drug treatment services in the same clinic (Reuters, 7/15).

Thailand
Although Thailand has been cited as a leader a leader in the fight against HIV/AIDS in developing countries, it has done "poorly" in addressing the spread of HIV among injection drug users, advocates at the conference said, the Bangkok Post reports (Smith, Edmonton Journal, 7/16). The Thai government last year launched a "crackdown" on drug use, which has left 2,500 people dead. Many advocates claim the deaths were extrajudicial executions by Thai police (Associated Press, 7/15). The campaign has helped to keep HIV prevalence rates among injection drug users at more than 40%, according to Toronto's Globe and Mail (Nolen, Globe and Mail, 7/19). There are no methadone centers and few drug rehabilitation centers in Thailand, and police responses to drug users are often violent, Paisan Suwannawong of the Thai Drug Users Network said during a closing speech at the conference (Apiradee, Bangkok Post, 7/17). About 50% of the country's injection drug users are thought to be HIV-positive (Reuters, 7/15). In addition, injection drug users are the only group at high risk of HIV transmission in the country with no reduction in HIV-prevalence rates over the last decade, Paisan said. Thai Prime Minister Thaksin Shinawatra said during the conference's opening ceremony that the country would begin implementing needle-exchange programs (Bangkok Post, 7/17). However, Public Health Minister Sudarat Keyuraphan on Wednesday said that the country would not legalize methadone for use in drug rehabilitation (Organization of Asia-Pacific News Agencies, 7/16).

Australian Broadcasting Corporation's "Asia Pacific" on Wednesday reported on Kampung Bali, a Jakarta suburb that has become a "focal point" for the HIV/AIDS epidemic in Indonesia, where up to 50% of injection drug users are thought to be HIV-positive. The segment includes comments from Dr. Pandu Riono, an epidemiologist with Family Health International; an HIV positive high school student; an HIV-positive injection drug user; and an AIDS outreach worker with Pelita Ilmu, a nongovernmental organization in Jakarta (Kearney, "Asia Pacific," ABC, 7/14). The complete segment is available online in Windows Media.

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